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Some Models of Grief and Loss
The world with which individuals interact is dynamic, constantly presenting changes and challenges that require reorganisation of perceptions, assumptions and behaviours. These changes can be sudden or expected, major or minor in their impact, and can result in either a positive or negative outcome. If it is considered that the resultant “world” or outcome is worse than the initial one, people are said to have suffered a loss (Parkes, 1994). Losses include loss of a person, such as a spouse, child, or friend; the loss of a living situation or lifestyle; abstract losses such as loss of control or personal identity; or perceived losses, such as separation from an important person or object (Rodgers & Cowles, 1991).
Parkes (1994) indicates that the most serious losses that people must adapt to are those that:
(1) require a major revision of a person’s set of assumptions about the world;
(2) have lasting consequences rather than transient; and
(3) are sudden and unexpected so there is little opportunity to prepare.
The loss experienced by a friend or family member of a person who has gone missing is considered to result in each of these types of losses.
Silove (1999) indicates that grief is a “normal” response to loss. Grief is the emotion that draws attention to the fact that someone or something is missing, and includes sadness, anger, shock, etc. (Rosenblatt, 1994, Parkes, 1994). In the 1980’s, John Bowlby hypothesised that the grief reaction was an extension of the general response people have to separation; that is, grief is a form of separation anxiety (Middleton, Raphael, Martinek & Misso, 1994).
Throughout life, people form attachments or bonds with parents, partners, children, peers and others, providing them with safety, security and a set of rules and assumptions about the world (Hasler, 1996, Parkes, 1994). People learn “attachment behaviours” that maintain these bonds, thereby enhancing their safety, security and their “world model” (Bowlby, 1980). When a bond is threatened, people use “attachment behaviours” to restore and strengthen the bond. If the bond is not restored, and separation from the attachment figure is permanent (such as in the case of death), an unbearable change results, causing disequilibrium and a loss of confidence of the world as a secure, reliable place (Parkes, 1994). Grieving is suggested to be the “attachment behaviour” people display as they make the psychosocial transition re-establish equilibrium (Parkes, 1994; Bowlby, 1980). It is a process of coping, learning and adaptation.
As Shimshon (1991-2) explains, loss is a double-process event. On one level, loss is an attack on the attachment bonds that develop between people, but it is also a major traumatic stressor, affecting the ability of a person to function biologically, psychologically and socially. Although grief is described as a highly individualised, dynamic, ongoing and all-encompassing process (Rodgers & Cowles, 1991), people who are grieving tend to experience some general, common elements. In providing support to people who are grieving, particularly those whose friend/family member is missing, it is important to acknowledge their individual expressions and symptoms. Professionals need also to be sensitive to the different cultural mores associated with the experience of grief. However, grieving people may also benefit from having a structure to their experience (Rosenblatt, 1994). It is important, therefore, that professionals are aware of the theoretical models of grief and how they may apply to different people at different times in the grieving process, but at the same time, do not place inappropriate expectations on individuals to rigidly follow these processes (Levy, Martinkowski & Derby, 1994).
Traditional models of grief have described the process in terms of stages or phases through which people typically pass (Worden, 1991). This conceptualisation is problematic, as people do not always continue through these stages/phases in sequence, and it is common for different phases to overlap. It is also frequent for special dates such as anniversaries and birthdays, contact with other people and external factors such as news coverage to cause people to re-visit earlier stages of grief. This is particularly true for the families and friends of missing people, who struggle to cope with many triggers for the loss, for example with media attention focussed on their particular case and/or items relating to other cases of a similar nature. Hewson (1997) suggests that these new crises and therefore new loss responses related to the initial loss will continue to occur for people throughout their lives.
The application of these stage/phase models to the unique experience of family members and friends of missing people is also difficult, as most models are based on loss due to the death of a loved one, as opposed to the ambiguous loss associated with uncertainty surrounding the fate of a person. Some research exists to suggest that wives, whose husbands are missing-in-action, report a pattern of grief similar to women whose husbands have died (Abbott, 1997), with the exception of final-stage acceptance of their loss, as it is uncertain that their husbands are in fact dead. It is suggested that the experience of families and friends of missing people is similar (Holiday-McGrady, 1992).
Grieving is suggested to come in “pangs” that are set off by reminders of the loss that have not yet been dealt with (Parkes, 1985). These pangs will be experienced and expressed differently at different times in the grieving process.
The First Few Days
In the initial stages of grief, theorists agree that the following emotional responses occur: shock, distress, disbelief, denial and numbness (Worden, 1991; Bowlby, 1985; Parkes, 1994; Hasler, 1996; Barbato & Irwin, 1992; Kubler-Ross, 1969). This immediate reaction to loss is often experienced as an oscillation between emotional blunting and disbelief and outbursts of panic or extreme tearfulness (Jacobs et al., 1987-8). Hewson (1997) describes this experience as the “primary stress episode” during which intense emotional and practical pressure is placed upon the person suffering the loss. The initial reaction to this pressure is suggested to be the body’s way of buffering the person against the heartache of the loss, to allow an intellectual acceptance that the loss is real. Indeed, Hewson (1997) indicates that the important challenge here is to develop an awareness of the loss that has occurred and the implications of this. In the context of families/friends of missing people, this phase would be akin to the first few days following the person’s disappearance.
Bowlby (1985) likened this reaction to the separation anxiety displayed when young children and animals are separated from important attachment figures. That is, when the attachment figure disappears, be it a child, partner, parent or peer, the response is one of intense stress and anxiety, and strong emotional protest aimed at restoring the bond (Worden, 1991). The loss of this relationship is experienced as psychological trauma, and if the person is unsuccessful in restoring the bond, withdrawal, apathy and hopelessness develop (Worden, 1991; Prigerson et al., 1997).
The Acute Reaction
The acute stage of grief sets in when the person begins to experience the emotional pain of grief. This stage includes intense feelings of pining and periodic waves of intense emotional and physical discomfort (Shuchter & Zisook, 1994). Yearning for the lost person occurs, and people struggle to hold onto or recover the lost person (re-establish the attachment), and are also drawn to places and things of the lost person (Bowlby, 1985; Jacobs et al., 1987-8). In the context of families and friends of missing people, this phase may also involve a frustrated physical search for the person.
Worden (1991) suggests that the task of this stage is to accept that the person is gone and will not return, on both a cognitive and emotional level. Society may make this phase difficult to pass through, particularly in the case of families and friends of missing people where uncertainty is a constant feature of their pain. That is, people may be uncomfortable with the griever’s feelings and may give out the subtle message that “you don’t need to grieve, you are only feeling sorry for yourself” (Worden, 1991).
This stage is also described as one where people “go through the motions” (Hogan, Morse & Credas Tason, 1996). That is, people will fluctuate between experiencing intense pain and anguish to dissociated states where they are able to think, perform and feel “normally” (Shuchter & Zisook, 1994). Others describe this phase as being in “limbo”, biding their time until the reality of their loss truly sinks in (Worden, 1991). Hewson (1997) explains this reaction in terms of “stress reduction”, where people attempt to restore a balance in their experiences such that the intensity of the stressor falls within their coping resources.
People can sometimes hinder the reaction in this phase by denying their feelings, remembering only pleasant thoughts of the lost person or using alcohol/other drugs to avoid the pain (Worden, 1991). However, Bowlby (1980) suggests that if people continue to avoid these acute reactions, they may carry this pain with them throughout their lives. It is much easier to process this grief reaction at the time of the loss, rather than further down the track. But again, for families and friends of missing persons, there is no certainty or finality and transition becomes the sufferers’ prison.
Chronic Relapsing
Distressful yearning for the person will continue over time, as the griever becomes engulfed with suffering over the lost relationship (Jacobs et al., 1987-8). Dejection and loneliness characterise their feelings (Hasler, 1996), and grievers will commonly sense the presence of the lost person, despite their physical absence (Parkes, 1994). This is particularly the case for families and friends of missing people. This “sense” of the person’s continued presence may indeed last for a long period of time after the loss occurs and perhaps forever for the families and friends of missing persons.
Disorganisation and despair will also set in, along with the realisation that the person’s old model of the world is no longer the true picture (Bowlby, 1985). Parkes (1994) indicates that in an attempt to preserve a sense of security and direction, people will surround themselves with familiar possessions, including those that remind them of the lost person.
At some point after the loss has occurred, people need to find the most adaptive means of modulating the painful affects of their grief (Shuchter & Zisook, 1994). Worden (1991) suggests this involves adapting to an environment in which the deceased/lost person is missing (Hasler, 1996; Worden, 1991). This includes realising the many different roles played by the lost person, and the search for meaning in the events that have occurred. Worden (1991) summarises this challenge not in terms of how to find an answer to the question of why the loss occurred, rather how to live without a reason for it. For families and friends of missing persons, this also means how to live with not knowing.
Silove (1999) suggests that types of extreme trauma, such as that experienced by families/friends of missing people, present people with threats to their world in terms of their sense of personal safety, of belonging/social cohesion, their sense of justice, their faith in the general “good” of people and their sense of identity and role functioning. Such major challenges to a person’s adaptive systems pose threats not only to the present identity of the person, but their sense of the future, and their place within it.
Grievers somewhat reluctantly adapt to the loss of a person, merely by deciding that they must fill the roles and develop skills to fill the gaps left by the lost person (Worden, 1991). They face the question of whether to retain components of life before the loss, or to change their world model based on the differences they obviously perceive in life without the lost person (Parkes, 1994).
People can often begin this process by giving themselves time off from their grieving (Stroebe, 1997). They adapt to altered relationships with others, and can re-develop a stable view of the world (Shuchter & Zisook, 1994). Stroebe (1997) suggests that it is important for the person to accept the reality that the world is changed, and to develop new roles, identities and relationships that are relevant for this world. In many cases, this involves the person changing their internal model of the world to match the reality of their lives (Parkes, 1994).
Bowlby (1980) suggests that this adaptation involves a reorganisation and development of new assumptions to replace the old ones. Some models of grief suggest that resolution comes by withdrawing emotional energy from the lost relationship and re-investing it in another relationship (Worden, 1991). In reality however, people seem to never lose the memories of a significant relationship, and theorists are now favouring models of grief that account for this need of griever’s to continue a relationship with the lost person. This is particularly relevant for the families and friends of missing people, who often are unable to resolve their loss, given they are not really sure whether the loss is permanent.
Although most people can make a substantial return to everyday functioning after loss, this does not mean they have returned to the level they were at prior to the loss. Indeed one way to define loss is a change where the outcome results in an end state that is poorer than the initial state (Parkes, 1994). It seems reasonable, thus, that full recovery from the loss may never be complete (Levy, Martinkowski & Derby, 1994). Horacek (1995) explains that people who are grieving need to be aware that even when the acute reactions have subsided, they will most likely continue to experience “shadow” grief, a basic sense of loss that will persist and be part of a continuing relationship with the missing person. Although there will always be some pain in recalling the memory of the lost person, those memories with time will lack the anguish of the acute reactions (Hasler, 1996). Hewson (1997) cautions, that there is potential in this phase for “secondary stress episodes” to occur that will take people back to vividly experiencing the pain of their loss. These could be specific events that trigger memories of the lost person (for example birthdays, milestones etc.) or they may arise from a build-up of events (such as work stress, fatigue, demands for time, lack of physical or emotional support) that tax the coping resources of the person. When this occurs, the reaction will not be as severe as that experienced during the “primary stress episode” however will require the individual to take steps to re-establish the balance in their lives (Hewson, 1997).
This model may be well suited to the experience of families and friends of missing people. With no tangible evidence to suggest the missing person is dead, families/friends struggle to reconcile the need to resume their lives with the desire to maintain hope that the person will return.
Ambiguous Loss
The reactions described above maybe appropriate for describing the general feelings experienced by families and friends of missing persons. However it is also important to account for the uncertain, ongoing nature of everyday life for these families/friends, who have little evidence to suggest that their loss is permanent. In physical death, the relationship to the deceased is permanently severed, however with a person who is missing, fate unknown, the bond is severed somewhat more slowly, incompletely and ambiguously (Dempsey & Baago, 1998). Their grief remains unresolved, creating ambiguity in terms of their social status, where the missing person fits in, and their future. Ambiguity of loss creates the most difficult challenge to the grieving process, particularly in terms of adaptation and resolution (Tubbs & Boss, 2000).
One study, that interviewed women whose husbands had abducted their child, revealed five patterns of coping that were similar in nature to that reported by “missing-in-action” wives (Holiday-McGrady, 1992):
(4) Emotional expression of their grief;
(5) Self-development/independence as they take on new roles to replace the ones involved with their child;
(6) Family involvement and maintaining family integrity in terms of reinforcing the strength of the remaining family as a unit;
(7) Escape and self-punishment as they attempted to distract themselves from thinking about their loss, but felt guilty at resuming elements of a “normal” life; and
(8) Involvement with peer groups, namely those who had been through a similar experience.
Efforts to console people suffering an ambiguous loss focused on managing the stressor, rather than on final, end-stage resolution of the loss. The ambiguity of loss can be likened to Hewson’s (1997) concept of experiencing “secondary stress episodes”. During these episodes, people benefit from stress reduction techniques, such as re-appraising their loss or reducing external demands, as well as from engaging in activities (such as counselling) to ease the painful emotions that they are experiencing (Hewson, 1997).
Individual Differences
Hewson (1997) emphasises that responses to loss are complex and multidimensional. As alluded to above, although there are some common factors in the experience of grief, individual factors will also impact on a person’s ability to move through the grieving process.
Who the person was
In order to predict how a person will respond to the loss of a person, it is important to understand something about that person and the relationship they had with the person left behind. For example, the loss of a distant cousin will be grieved differently from the loss of a child (Worden, 1991).
The nature of the attachment
The experience of grief will also be predicted by the nature of the attachment the person had with the lost person. Important in this is the strength and security of the attachment, the presence of any negative or ambivalent feelings toward the lost person, and the nature and extent of conflicts between the griever and the lost person (Worden, 1991). Parents in particular seem to need to respond to a child’s death or disappearance in a public way, in an effort to resolve the challenges that the loss of a child presents to their competence as a parent (Klass & Marwit, 1988-9).
Mode of loss
It is true that how the person was lost will impact heavily on the way in which a person grieves that loss. For example, unexpected, sudden losses, such as those surrounding missing people, will complicate the grieving process (Bateman, 1999). Families and friends of missing people are unprepared to deal with this loss, and struggle with their inability to say goodbye to the person and to make things right. In addition, the degree of preventability of the incident, as perceived by the person who is grieving, will also influence the duration and intensity of grief (Klass & Marwit, 1988-9).
Historical antecedents
Another important factor in predicting a person’s response to loss, is the way in which they have experienced and dealt with loss in the past (Worden, 1991). Central to this element is whether there are any unresolved losses that may impact on the current grieving process. It is further important to determine whether the person has a history of depressive illness or anxiety as these people will have a more difficult time grieving (Worden, 1991).
Personality variables
Doka and Martin (1998) suggest that men and women choose different strategies to adapt to loss. In the initial stages of grief at least, men tend to deal actively with their loss, by arranging funerals, dealing with coroners etc. (Riches & Dawson, 1996). This may also be the case with families and friends of missing people, with the males being actively involved in the search for the missing person, and in handling interactions with police. Women tend to look inward in the initial stages of grief, by feeling and expressing a range of strong emotions. Riche and Dawson (1996) suggest that the public work of expressing grief is likely to come from females, while men cope by doing. However, these are generalisations and may vary in individual cases. This difference in grieving style often makes communication within families difficult (Walter, 1996).
Other factors will also make a person more vulnerable to experiencing grief at a more intense level. For example, people with a pattern of low or unstable self-image, those with a history of child abuse or neglect, and those with poor affect modulation become increasingly insecure and unstable in the face of grief (Prigerson et al., 1997)
Social variables
In particular, the quality of a person’s social supports will play a role in their ability to cope with loss (Klass & Marwit, 1988-9). Research has indicated that perceived availability of social support in the aftermath of loss predicts the extent to which a person is able to cope (Worden, 1991). In addition, cultural and religious customs will provide people with guidelines and rituals for grief behaviour.
Concurrent stresses
Other stresses experienced during the grieving process will reduce an individual’s ability to cope (Levy, Martinkowski & Derby, 1994). These include day-to-day pressures such as balancing work and family commitments, fatigue, poor relationships with people in support network and so on.
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